Surgical apparatus for closing wounds

ABSTRACT

There is described apparatus for repairing lacerations or closing surgical incisions by means of a pair of carrier strips on which are mounted a plurality of curved stylets that can be inserted into the tissue on either side of the wound. A combined applicator, fastener, and bandage is used to grip a strip during insertion of the stylets into the tissue and then used as a strap connecting the two strips together to draw the carrier strips together on either side of the wound, so as to close the wound and at the same time act as a dressing for covering the wound.

United States Patent 1191 McDonald 51 July 23, 1974 SURGICAL APPARATUS FOR CLOSING WOUNDS [76] Inventor: Bernard McDonald, 18212 Pacific Coast Hwy., Malibu, Calif. 90265 [22] Filed: Apr. 23, 1973 [21] Appl. No.: 353,229

[56] References Cited UNITED STATES PATENTS 9/1902 Brown 128/337 7/1903 Lukens 128/337 128/337 2,201,610 5/1940 Dawson, Jr. 2,421,193 5 1947 Gardner 128/335 2,551,902 5 1951 Rieck.... 128/218 R 2,811,971 11 1957 Scott.. 128/335 3,134,152 5/1964 Pei 128/335 x 3,142,158 7/1964 Podolsky 128/214 A x llll 7/1971 Pistor 128/215 3,595,231 3,741,211 6/1973 Vreeland, Jr. 128/215 FOREIGN PATENTS OR APPLICATIONS 854,340 l/1940 France 128/335 Primary Examiner-Aldrich F. Medbery Attorney, Agent, or Firm-Christie, Parker & Hale [57] ABSTRACT There is described apparatus for repairing lacerations or closing-surgical incisions by means of a pair of carrier strips on which are mounted a plurality of curved stylets that can be inserted into the tissue on either side of the wound. A combined applicator, fastener, and bandage is used to grip a strip during insertion of the stylets into the tissue and then used as a strap connecting the two strips together to draw the carrier stripstogether on either side of the wound, so as to close the wound and at the'same time act as a dressing for covering the wound.

9 Claims, 11 Drawing Figures .l rh 511' (nu/luv In 1. VIII)... 1' '"ln III! m'lllm Mam. reissues! SURGICAL APPARATUS FOR CLOSING WOUNDS FIELD OF THE INVENTION This invention relates to surgical appliances, and more particularly, is concerned with apparatus for closing a wound and holding it closed while providing a dressing during healing.

BACKGROUND OF THE PRESENT INVENTION It is conventional practice to close wounds from a laceration or surgical incision by using sutures or clamps' Sutures present a number of problems. They are slow and tedious to apply. They cannot be adjusted during the healing operation to maintain the desired tension, particularly if there is any swelling during the healing operation. Sterilization is a problem particu larly on removing the sutures, since the sutures must be pulled through the tissue, thereby exposing the tissue to a possible source of contamination. While various types of clamps or skin clips have been proposed, such clamps are difficult to apply. Clips usually require some special tool for applying them, which presents the added problems of availability, sterilization, and cost.

SUMMARY OF THE INVENTION The present invention is directed to improved apparatus for closing and dressing a wound. The'invention has the advantage that it is completely self-contained and can be packaged as a sterilized unit. It can be adjusted during use to vary the pressure in the region of the wound without the need for further surgery or anesthesia. The invention also provides an efficient means of anesthetizing the area surrounding the wound. The apparatus at the same time acts as a dressing for covering the wound during the healing process.

In brief, the above advantages are achieved by an arrangement in which a plurality of curved stylets are supported at one end by a carrier strip. One such strip is held on either side of the wound by inserting the associated stylets into the tissue, with the stylets associated with the two strips curving towards each other. An elongated strap, hinged at the middle by a flexible intermediate section is used in tweezer fashion to grip FIG. 6 is a plan view of the fastener applicator and fastener strap;

FIG. 7 is an alternative embodiment of the strap of FIG. 6; I

1 FIG. 8 is a sectional view taken substantially on the line 8-8 of FIG. 7; and

FIG. 9 is a plan view of an alternative embodiment of the invention;

FIG. 10 is a further embodiment of the invention.

indicates generally an elongated carrier strip which is preferably molded of a semi-rigid plastic material. Supported by the strip 10 in cantilever fashion are a plurality of curved stylets or needles 12 which are preferably fabricated from stainless steel or other suitable metal having high tensile strength with a very thin crosssection. One end 14 of each stylet terminates in a very sharp point, while the other end 16 is formed to provide a flattened base, which is embedded in the plastic of the carrier strip 10 during the molding operation. The stylets are thus securely anchored in parallel relationship with the pointed ends 14 extending in the same direction.

The carrier 10 is formed with a plurality of projecting fingers 18 which extend in the same direction as the curved stylets 12. These fingers provide a greater effective width for the strip while still retaining some longitudinal flexibility so that the strip may be contoured to the skin on application. In addition, the carrier may be scored or molded with a slight indentation, as indicated at 20, in the top surface of the carrier strip at various spaced points intermediate the fingers 18to permit sections of the carrier to be snapped, providing shorter lengths as required.

Referring to FIGS. 3-6, the manner in which the carrier strip with its associated stylets are used in closing a wound is shown. Numeral 22 indicates an open lacereach of the strips, providing a handle for inserting the.

stylets into the tissue. The strap isthen secured to the two strips to hold the edges of the wound together and at the same time to cover the surface of the wound.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 5 is an enlarged partial sectional view of the area indicated at in FIG. 4;

ation or surgical incision extending through the epidermis 24, subcutaneous tissue 26 into the muscle tissue 28. One of the carrier strips 10 is positioned on either side of the margins of the wound 22, and the curved stylets 12 are caused to puncture the skin and enter into the subcutaneous tissue. The stylets of the two carrier strips are inserted so that the stylets curve towards each other on either side of the wound. When the stylets are fully inserted, the carrier strips lie flush against the surface of the skin with the fingers l8 projecting towards each other on either side of the wound. Because the carrier strip is semi-rigid it can be bent in a curve along its narrow dimension. As a result the tips of the stylets are displaced from'the normal straight line so as to lie along a curve line. Thus the tips of the stylets, when initially engaging the surface of the skin during insertion, enter the skin along a curved line which follows the curve in the margin of the open wound. As the curved stylets enter deeper into the tissue, the line of entry of the tips is forced to become straight when the stylets are fully embedded, causing the margins of the wound to be forced together. See FIG. 2-A which shows the carrier strip deformed into a slight curve.

Because the carrier strips are quite small, being of the order of a centimeter in width, including the fingers 18, and being of 2% to 5 centimeters in length, typically, an applicator is used to hold the carrier strip during insertion of the stylets into the tissue. The applicator, in-

closed duringhealing. As indicated in FIG. 4, at the 7 same time the strap provides a dressing which covers the wound, protecting it from dirt and contamination.

The combined applicator and bandage strip is preferably formed of transparent plastic material in three contiguous sections, two relatively stiff end sections 32 and 34, and an intermediate flexible section 36. The end section 32 is formed with a plurality of indentations 38, as seen in FIG. 6, which have the same spacing as the stylets 12. The end sections 32 and 34 are made more rigid by integrally formed stiffening ridges 40. The ridges 40 extend'between the indentations 38.

When used as an applicator, the ends of the strap 30 are brought together by folding at the relatively thin intermediate section 36. As shown in FIG. 3, the folded strap is gripped between the thumb and fingers of the user and used to clamp the carrier on opposite sides. The indentations 38 receive the stylets so that the full width of the strip 10 can be gripped. The inner end surfaces of the strap 30 may be roughened, as indicated at 42 and 44, respectively, to provide improved gripping action with the carrier strip 10.

After the stylets of both carrier strips are fully inserted into the tissue, the applicator strap is flattened out and. secured to the carrier strips so as to protect the wound while at the same time holding the edges of the wound together. To hold the strap 30 to the carrier strips '10, the strap may be provided with a plurality of rows of holes, one row of holes being in the end section 34, as indicated at 46, and three or more rows of holes being provided in the end section 32, as indicated at 48, 50 and 52. Each of the carrier strips is provided with a row of projecting lugs 54 on the top surface of the carrier adjacent the end of the fingers 18. The row of lugs is adapted to be inserted into a row of holes in the strap 30, as shown in detail in the enlarged sectional viewof FIG. 5. The lugs 54 are preferably formed with an undercut margin 56 which helps grip the margin of the associated hole'in thestrap sections 32 and 34 when the strap is under tension.

The three separate rows 48, 50 and 52 provide a means for adjusting the spacing between the two carrier strips when closing the wound. The arrangement of indentations 38 along one edge of the strap 30 and the reinforcing ridges 40, together with the holes between the reinforcing ridges, permits the strap to be readily torn edgewise at any selected one of the indentations 38 to narrow the strap to the desired width depending upon the size of the wound and the length of the carrier strips being used. Other means of securing the strap to the carrier strips may be used,'such as Velcro material, hook and eye, snaps, or the like, which permit adjustment of the strap length between the carrier strips on eitherside of the'wound. Y

FIG. 7 shows an alternative strap arrangement in which a flexible intermediate section 36, extending between the two relatively stiff end sections 32' and 34,

is made considerably longer than in the strap of FIG. 6. The rows of holes 46., 48, 50, and 52 are formed in the flexible intermediate section 36. After use as an applicator, the two end sections 32' and 34 may be torn away from the intermediate section 36', and the intermediate section used alone as the strap for com- 4. bining the two carrier strips together and forming a dressing over thewound. I

A further embodiment of the invention is shown in FIGS. 8 aand 9 in which the curved stylets 60 are made of a very .thin, hollow tubing in the manner of a hypodermic needle. The hollow stylets are mounted in acarrier strip 62 with the supporting end of the stylets extending through to the opposite side of the carrier strip ,62. The carrier 62' is provided with lugs 64 and adjacent the lugs are attached small flexible plastic ampoules 65 which can be filled with anesthetic fluid, the fluid cavity of the ampoule being in communication with the hollow interim of the stylets. The carrier can be inserted by an applicator which grips the carrier strip on the top of the lug 64 so as not to compress the ampoule 65. As the stylets are gradually embedded inthe tissue, the ampoule 65 can be squeezed, forcing the anesthetic or other fluid out through the hollow hypodermic tubing of the stylet 60 into the tissue at a rate to numb the tissue ahead of the stylet tips. As shown in FIG. 8, the several separate ampoules 65 are provided so that the carrier strip may be separated between the ampoules without breaking open the ampoules. v

Referring to FIG. 10, there is disclosed a further embodiment of the invention which comprises a carrier strip 66in which is anchored a plurality of stylets 68. The stylets are angular in shape rather than a continuous curve, which may provide a better anchor particularly where the surrounding tissue is very soft. The carrier strip 66 forms one wall of a chamber 70 formed by flexible corrugated side walls 72 and a top wall 74. The chamber is filled with anesthetizing fluid which is in communication with a hollow tube formed by each of the stylets 68. Prior to use, the ends of the stylets 68 are sealed off by a sealing strip 76 into which the tips of the stylets are embedded. The sealing strip 76 is removed .when ready for use.

As in the arrangement of FIG. 8, a plurality of separate chambers 70 may be provided along the length of the carrier strip 66 permitting the carrier strip to be separated into shorter lengths by the user as required. The corrugated walls are formed of a flexible plastic and constructed to offer enough resistance to external pressure that the surgeon seizing the strip with the applicator grip will not, while using the ordinary care and skill of his craft, inadvertently express the anesthetic fluid prematurely. However, after inserting the points of the stylets into the superficial skin, the surgeon exerts an increased forceon the gripper sufficient to initiate a collapse of the chamber to-commence expulsion of the anesthetic fluid into the skin. By increasing the squeezing pressure as thestylet points advance into the tissue, the tissue can be anesthetized ahead of the advancing tips of the stylets, in a manner conventionally used with hypodermics. I

Instead of using an anesthetic fluid, theampoules or chambers could be filled with a normal physiologic saline solution. Prior to use, the strip is refrigerated to reduce the temperature to approximately 4 to 10 C. This chilled fluid when injected in the neighborhood of the regional nerve fibers reduces their temperature and x mechanically compresses the fibers, both factors leading to a reduction or temporary absence of conductivity so that the zone is temporarily anesthesized. To obtain the desired effect, a volume of approximately 0.5 millilitersper cubic centimeter'of soft tissue injected produces the desired anesthetic effect. For example, to

close and anesthetize a wound which is 2.5 centimeters in length and 1 centimeter deep requires approximately 3 milliliters of saline administered peripherally a distance of approximately /2 centimeter from the margins of a wound, Stylets are inserted to a depth approxi mately equal to the depth of the wound and the fluid is ejected continuously while the stylets are being inserted to their maximum penetration. The compression and reduction of temperature of the nerve fibers produces the anesthetic effect, which lasts for several minutes. I 1

From the above description, it will be recognized that anon-suture wound-closure device is provided which is safe and easy to use. No accessory equipment, such as sterile needle holders, surgical scissors, bandages, or surgical dressing is required. It may be packaged in sterilized ready-to use form. The strap material may be transparent so that progress of wound healing may be observed without removal of the strap. It may be used for anesthetizing an area before an incision is made, such as during the removal of a lesion, and then, without removal from the skin tissue, be used to close up the wound. Because'of the curved shape of the stylet, the carrier strips remain firmly in place even though the area is not completely immobilized. The strap can be readily adjusted without removal of the stylet to relieve pressure during the healing process or to permit drainage of the wound. The arrangement of the present invention provides improved blood circulation in the area of the wound as compared to the usual suturing technique.

While the invention is described as useful in the closing of skin and other superficial wounds, it will be apparent that it has many other applications, such as the rapid closure of ruptured organs within the body where rapid life-saving measures 'are essential.

What is claimed is: i

1. Apparatus for closing a wound comprising a plurality of curved stylets, a carrier strip of semi-rigid material, one end of each stylet being received in and rigidly anchored in the carrier strip, the anchored ends of the stylets being spaced along and in a single row lengthwise of the carrier strip, the stylets being parallel to each other, the carrier strip having a substantially flat surface on one side, the stylets projecting out of said surface adjacent one edge of the strip with the stylet projecting in the direction of the opposite edge of the strip.

2. Apparatus of claim 1 further including releasable be readily broken off between adjacent stylets to selectable lengths.

5. Apparatus of claim 1 further including means forming a compressable chamber on the opposite side of the carrier strip from said flat surface, the carrier strip forming one wall of the chamber, at least one stylet having a passage extending the length of the stylet and communicating with the interiorof said chamber.

6. Apparatus for closing a woundcomprising a pair of tissue-gripping units, each unit including an elongated carrier strip and a plurality of parallel curved cantilever-supported hooks having one end anchored in the strip and the other terminating in a very sharp tapered point, and means for adjustably mounting said carrier strips means detachably connected to and extending between the carrier strips for holding the strips in spaced relationship to each other with the points of the hooks associated with one carrier strip extending toward the point of the hooks associated with the other carrier strip said mounting means comprising a strap of flexible material, and means detachably securing the strap to each of the strips at selected positions along the length of the straps to hold the strips in variably spaced parallel relationship to each other.

7. Apparatus of claim 6 wherein the strap includes two sections at either end that are relatively rigid joined by a flexible intermediate section, the strap being foldable in the flexible section to bring the two end sections together to form a tweezer-shaped applicator for gripping each of the strips during insertion of the hooks into the tissue adjacent the wound.

the strap are separable from the intermediate section. 

1. Apparatus for closing a wound comprising a plurality of curved stylets, a carrier strip of semi-rigid material, one end of each stylet being received in and rigidly anchored in the carrier strip, the anchored ends of the stylets being spaced along and in a single row lengthwise of the carrier strip, the stylets being parallel to each other, the carrier strip having a substantially flat surface on one side, the stylets projecting out of said surface adjacent one edge of the strip with the stylet projecting in the direction of the opposite edge of the strip.
 2. Apparatus of claim 1 further including releasable attaching means on the carrier strip on the side opposite said flat surface by which a band may be attached to the carrier strip.
 3. Apparatus of claim 1 wherein the carrier includes a plurality of integral fingers projecting along one edge and forming an extension of said surface, the fingers extending in the direction of the curved stylets.
 4. Apparatus of claim 2 in which the carrier is scored in a direction parallel to and between the planes of the stylets and between the fingers to permit the carrier to be readily broken off between adjacent stylets to selectable lengths.
 5. Apparatus of claim 1 further including means forming a compressable chamber on the opposite side of the carrier strip from said flat surface, the carrier strip forming one wall of the chamber, at least one stylet having a passage extending the length of the stylet and communicating with the interior of said chamber.
 6. Apparatus for closing a wound comprising a pair of tissue-gripping units, each unit including an elongated carrier strip and a plurality of parallel curved cantilever-supported hooks having one end anchored in the strip and the other terminating in a very sharp tapered point, and means for adjustably mounting said carrier strips means detachably connected to and extending between the carrier strips for holding the strips in spaced relationship to each other with the points of the hooks associated with one carrier strip extending toward the point of the hooks associated with the other carrier strip said mounting means comprising a strap of flexible material, and means detachably securing the strap to each of the strips at selected positions along the length of the straps to hold the strips in variably spaced parallel relationship to each other.
 7. Apparatus of claim 6 wherein the strap includes two sections at either end that are relatively rigid joined by a flexible intermediate section, the strap being foldable in the flexible section to bring the two end sections together to form a tweezer-shaped applicator for gripping each of the strips during insertion of the hooks into the tissue adjacent the wound.
 8. Apparatus of claim 7 wherein at least one end section of the strap is formed with a plurality of equally spaced projecting fingers, the fingers being spaced to fit into the spaces between the parallel hooks.
 9. Apparatus of claim 7 wherein the end sections of the strap are separable from the intermediate section. 